500kg cow, 10% dehydrated, pipe stream diarrhea of 24h duration at a rate of 3L/hr....depressed and in need of rapid fluid resuscitation. What's her fluid deficit?
weight x% dehydration= 50L deficit
500kg cow, 10% dehydrated, pipe stream diarrhea of 24h duration at a rate of 3L/hr....depressed and in need of rapid fluid resuscitation.. How fast can you replace her fluid deficit?
well 500kg x 80ml/kg bolus= 40L....but your cath tops out around 25L/hr....so we can get the 40L bolus within 2 hours. **if RAPID resuscitation not needed, give 1/4 bolus in first hour, 1/4 next hour, and then The last over the next 12hr
500kg cow, 10% dehydrated, pipe stream diarrhea of 24h duration at a rate of 3L/hr....depressed and in need of rapid fluid resuscitation.. what is her maintenance requirement?
It's 50ml/kg/A DAY! for an adult cow, so 50mlx500kg= 25L/Day (and then divide by 24 for an hour)= 1L/hr maintenance. **remember if she is lactating that every 1L of milk requires 3L water.
500kg cow, 10% dehydrated, pipe stream diarrhea of 24h duration at a rate of 3L/hr....depressed and in need of rapid fluid resuscitation.. What are her ongoing losses?
Diarrhea 3L/hour (add this to the deficit and maintenance)
how does she math when there is maintenance+deficit+ongoing loss, versus a shock dose
for M+D+O, she has a little bit of each in the fluid plan in every hour. So the ongoing loss in L/hr+ maintenance in L/Hr+ one quarter of the deficit in the first hour= this is your first hour of the fluid plan. But with the shock dose its 80ml/kg/hr and you really can't add any more to that because its the max amount (remember you divide this into 20ml/kg boluses at a time, prolly every 15min to get to 80ml/kg in an hour)
500kg cow, 10% dehydrated, pipe stream diarrhea of 24h duration at a rate of 3L/hr....depressed and in need of fluid. Her overall fluid plan?
You giver her a bolus over 2 hours (the deficit, so 20L in the first hour, 20L in the second) and add 4L for maintenance and ongoing losses (3L/hr for diarrhea and maintenance is 1L/hour) so then its 24L/hour for the first two hours. THEN REASSESS. If no further deficits then continue with just maintenance+ongoing loss= 4L/hr (she also said: say this cow had a 50L deficit, we essentially gave her 40L for the bolus for the deficit, so we still have 10L of deficit left over ((bc maintenance+ongoing losses doesnt cover the deficit, that goes towards her ongoing loss and her basic fluid needs) So then with the last 10L we can just decide if we want to give them that in the 3rd hour, or split it up over the next few hours. **just understand that youre still behind with the deficit after the first 2 hours
500kg cow, 3rd lactation, 10% dehydrated, 3L/hour diarrhea for 72hr duration. not in need of rapid fluid resuscitation (BC SHE IS STILL DRINKING). How do you proceed?
Make sure she still has plenty of water to drink, if with plenty of water she's still 10% behind, then consider IV. dont have to rapidly bolus her like the other cow, so can divide it up more
What is different about a neonates vasculature, what implications does this have with fluid therapy?
They have compliant vasculature (integrity isn't as much as an adults) which makes them easier to fluid overload, and it is harder to attain perfusion pressure as inc BP results in edema development (leaky vessels)
how does a calves Vd compare to an adults, why?
They have a larger surface area to body weight, so they have a larger Vd.
what is the size cath you'd use for a calf?
avg sized calf= 16G cath (so smaller than adult which is more like 14, so implications for fluid rate- inc resistance, drops volume we can get in)
with little neonates, for the bolus, you..
divide it up to 20ml/kg at a time, reassess in between))
if you want to give fluid deficit volume to neonate where they do not need rapid volume resus, you can..
can be given over 12 hours like in adults
what is more reflective of dehydration than pH?
poor suckle reflex
DEAR GOD, MAINTENANCE IS IN DAYS
4d old calf with profuse diarrhea, getting worse. 40kg, Has cool extremities (shocky). She is 8% dehydrated. How much fluid needed to replace fluid deficit?
40kgx8%= 3.2L (so basically 3L)
4d old calf with profuse diarrhea, getting worse. 40kg, Has cool extremities (shocky). She is 8% dehydrated. what are her hourly maintenance requirements?
40kg x 80ml(kg/DAY)= 3.2L/day= 133.3ml/hour
4d old calf with profuse diarrhea, getting worse. 40kg, Has cool extremities (shocky). She is 8% dehydrated. Producing 200ml/hr of diarrhea. How much to bolus this calf?
total deficit: 3L (bolus), maintenance is 133mL, ongoing is 200ml/hr. (if you were to add these all together for the first hour it'd be like 3.5L so thats too much) SO in the first hour (divide 3L into quarters... first hour is a quarter of the deficit which is 750ml + maintenance (133ml) + ongoing (200ml)= about 1L/ first hour. (remember 80ml/kg/hr is the max shes comfortable with giving at a time, for this calf that means not comfortable giving over 3L in an hour)
4d old calf with profuse diarrhea, getting worse. 40kg, Has cool extremities (shocky). She is 8% dehydrated. What is her bicarb deficit (how much bicarb do you want to give her in mmol) her bicarb on bloodwork was 15mEq/L. How much 1.3% bicarb fluid do you wanna give her?
BASE DEFICIT= 25-15=10mEq/L. And then Bicarb deficit= weight x base deficit x factor (0.3) so that's 40kg x 10mEq/L x 0.7= 280.... now, the 1.3% bicarb fluid has 156mmol/L bicarb, so you want to give 1.7L of this fluid (280/156)
LRS HAS Ca++...CANT ADD BICARB, it will precip out. SALINE IS acidifying, we don't want this (acidifying bc <40 on strong ion scale). Plasma Lyte 148 is the correct answer. D5W (i think this is the dextrose) has no electrolytes and your pt is losing elyte in the diarrha so you want those.
90kg calf 10% dehydrated. what total vol of fluid can you give as a shock bolus in first hour of tx?
90x80=7.2L (bc max per hour is 80ml/kg/hr)
90kg calf is 11% dehydrated. what would fluid plan be like for first 3 hrs if she needs rapid fluid resus.?
DEFICIT: 90kgx0.11= 9.9L. MAINTENANCE: 80ml/kg/DAY= 7.2L/DAY divided by 24= 0.3L/hr. She needs rapid fluid resus-- max you can give in an hour is 7.2L in the first hour as a bolus. So Quarter that (20ml/kg at a time) so 1.8L bolus, recheck, another, another, another all in the first hour. HOUR TWO: you still have 2.7L deficit remaining (9.9deficit-7.2from first hour) and then you can account for maintenance....so 2.7L from deficit+0.3L maintenenace= 3L in second hour. THIRD HOUR: now the deficit is elim, so give maintenance (0.3L) in this house, reassess to see if they have enough fluid. (since there are 1L/5L bags a practical answer would be 5L first hour, 5L second hour, and then maintenance after that)
So if she says "rapid fluid resus."...
immediately the first hour is just the shock dose (80ml/kg/hr) divided up into quarters but still within the first hour. This is the max you can give. so then in the 2nd hour you try to then give the rest of the remaining deficit and if there is room, consider the maintenance
overhydration will risk edema, particularly of..
the brain and lungs...and also it will confuse the kidney and they kidney start crazy peeing it out bc think fluid overloaded
500kg cow diarrhea for days. shocky. she has 10mEq/L bicarb. What is her base deficit? what is her bicarb deficit? how many L of 1.3% bicarb solution?
15 (25 which is normal, minus 10 is a difference of 15 which is her deficit) THEN 500kg x 15 x 0.3 (adult)= 2250mmol needed. so 156mmol/L of bicarb in 1.3% solution so 2250/156= 14.4L
50kg calf shocky, Na= 125, K is 4, HCO3 is 15, Cl is 115- what is the strong ion difference? What is the metabolic abnormality in this calf?
SID= Na + K - Cl so.... 125+4-115= 14. AND <40 MEANS ITS AciDOTIC. (SID is kinda like pH where low number means acid, but 40 is neutral instead of 7). So it's an acidosis, the bicarb is low so its a metabolic acidosis(or it just says metabolic in the question, idk man). And then she mentioned something about a gamblegram, and said you need to pay attention to how the Cl- level is moving around too. So if the bicarb changes, you can use resp. system to balance it out with CO2 and such. But if you change the Cl-, then you need to replace it with another negative ion to be electronically balanced. If Cl- comes down, space gets filled with bicarb....and bicarb inc makes alkalotic. SO anyway, we have a HYPERchloremic metabolic acidosis
Na 145, K is 4, HCO3 is 20, Cl- 109. What is her anion gap?
(Na + K) - (Cl + HCO3) sooooo (145+4) - (20+109) (149-129)= 20 is your anion gap.(normal is 12-16) so....elevated anion gap= ACIDOTIC. Cl- is normal, what is most likely filling in that gap? Lactate.
what is the problem with treating a hypovolemic and metabolically acidotic calf with D5W (5% dextrose in water)?
Causes RBC LYSIS
you have corrected fluid deficit of a 45kg calf who you are treating for diarrhea. how much fluid must you continue giving to this calf per hour, if she is still losing 300ml/hr of diarrhea?
maintenance + ongoing losses.... so 80x45= 3.6L/day / 24= 150ml.... ongoing loss= 300ml... so 450ml/hr
weight times dose divided by concentration! Dont forget to look at your units!
to provide sufficient bicarbonate to your 50kg calf patient you need to add 10meq/kg body weight of bicarbonate to the solution, How much of an 8.4% hypertonic bicarbonate solution must you add?
50kg x 10meq/kg= 500meq needed. And then you have your solution, as there is 1meq / ml in an 8.4% HBS solution you will need to add 500ml of the 8.4% solution. 1 meq/ml Na & HCO3
how much mEq of bicarb are in how much of a 1.3% NaHCO3 solution?
156mEq PER LITER.
what happens if you give dextrose and water alone?
can lyse RBCs (i think if the dextrose gets used up by the cells then its hypotonic solution and then water flows into RBCs--> lysis)
8.4% bicarb has how many mEq?
1mEq bicarb per ML
How much 50% glucose solution must i add to a 5L bag of isotonic saline to make up a 10% glucose solution?
C1 x V1= C2 x V2 aka concentration you want x volume you want to end up with / concentration you have to dilute= volume you will need to dilute out... SOOOO 0.1(10%) x 5000ml(5L)= 0.5 (50%) x "Y" so then divide (0.1x5000)/0.5= "Y" so "y" equals 1000ml (of the 50% glucose must be added to the isotonic saline.
How many g of glucose will be in 1L of a 10% glucose solution?
REMEMBER THAT CONCENTRATION IS EQUAL TO THE GRAMS OF STHING IN A VOLUME. so that means if C=G/mL, then CxmL=G so 0.1 (10% conc) times 1000 ml (1L)= 100g
IF YOU SEE A CONCENTRATION IN PERCENT..how do you put it into a math equation
JUST REMEMBER TO MULTIPLY BY TEN. so 5% is 50mg/ml
What aspect of a catheter is the MOST important factor in terms of maximizing fluid flow?
remember with blood gasses
ROME (respiratory opposite, Metabolic equal...so see if the HCO3/CO2 is moving in the same direction as the pH (up or down)